Katie next to Gram with her beau, Andrew; Thalia on the right wondering what in hell a selfie stick is; and John and I.

Last Friday my mother fell and broke her pelvis. She was simply turning around, lost her balance, and landed on her side on a padded carpet. That is all it took to fracture her bones.

She was in a great deal of pain and could not support her own weight.

911.

Right away calm and capable EMTs arrived and gently transported her to the Emergency Department at the hospital in Northampton. Soon her pain was under control, but it took a lot longer to diagnosis the two pelvic fractures. Osteoporotic bones are not easy to read and x-rays were inconclusive. Fortunately the ER doctor went a step further and a CT scan revealed the fractures.

Now the story starts to seem a little bit like a Fellini movie.

After being told that they had a bed for my mother and that they would transfer her out of the E.D., I went home. The next morning I returned to the hospital, hoping to find out what the orthopedist would recommend for her treatment. I found a social worker standing over my mother, at the foot of her bed explaining that she had not been admitted to the hospital; she was there under observation. As a result of this designation Medicare would not cover her time in the hospital. Furthermore, if she did not spend three nights there as an admitted patient, Medicare would not pay for her subsequent and necessary rehabilitation. Really? Are you sure? The unsympathetic social worker was explaining this system in acronyms to a 91 year old, in pain, who had not eaten since 2 the previous day.

My mother was dressed in a Johnny, lying in a hospital bed, wearing a hospital wrist band, being cared for by nurses, and eating hospital food, but she was there under observation.

The status difference between admission and observation is the dirty little secret of Medicare. Medicare laws have not changed, but this so-called entitlement has independent contractors scrupulously auditing hospital claims.

So... I am looking at my arthritic, broken, mother who also has COPD, macular degeneration, osteoporosis, and a pending diagnosis of Parkinson's disease and trying to explain to her that her insurance isn't going to cover this hospitalization. I was scurrying to get up to speed on how to apply to rehab. without Medicare, and to understand this system.

I asked to have her status re-evaluated and to have her admitted. I asked her primary care physician to call the hospital and explain her other health issues since the hospital only had the Emergency Room details. I asked to speak to the team who makes this determination.

I was told that it was not possible to meet with the team and the social worker could not tell me how many people make up the team and who is on it. I was also told that for future reference it was not necessary for me to contact the P.C.P. because it was the hospitals' decision alone. Was that a reprimand? Who are these people?

Dazed and confused.

Maybe my persistence helped a little, maybe the call from my mother's caring P.C.P. helped, maybe the nurse practitioner who cared to listen to us and get all the information tipped the scale. The waters parted and finally on Sunday morning the hospital called me and said that my mother was officially admitted! They said her oxygenation was low and that is why they changed her status. Her oxygenation was in the 80's (94 is nice) and it had been ever since her arrival in the Emergency Dept.

This change -- changed everything. Now Medicare covered her hospital stay and her upcoming rehab!

Squeak, call, ask questions.

We were at the hospital twice a day and at one point there were five guests clustered around my mother's bed with flowers, cards, and newspapers. We had questions for everyone who came into the room. My mother had a village of advocates and supporters. She was not alone and she could not be overlooked.

What happens to old people who are alone? My mother's hospital roommate never had a visitor and we were told that she had no family. If she had a broken pelvis, and she was there under observation, would they send her home with only aid visits once a day instead of the necessary skilled full-time care that she really would need from a rehab. facility?

It seems like the hospitals are in a hard spot; they can not manipulate this policy without the risk losing medicare reimbursements. Through AARP I discovered that there is a class action suit against Medicare regarding this issue.Eldercare attorneys are in demand by patients who have been financially wiped out because of this nasty little ploy. AARP is trying to let people know about this situation, but Medicare will not speak with them about it. By the time the boomers need Medicare, if it still exists, doctors may not even accept it because of the risk or non-reimbursement.

I am writing letters and emails and trying to shed a little light on this issue. I feel like Sisyphus pushing the boulder up the hill and getting nowhere, but I think I would prefer being crushed by that boulder than living to old age in the current nightmare of insurance and health care.

My mother is doing very well and she is in good spirits. Upon release from the hospital she decided to head back to the Granite State to be closer to my six siblings and their spouses. We miss her and pray that she gets loving, consistent care in the Rehabilitation "industry".

One of the saddest things for us now, besides the difference in care, is that my mother and my mother-in-law will no longer have their daily contact. They encouraged each other and shared a lot of laughs. They forged a beautiful friendship here at The All Day Cafe.

wow.
sending tons of love and resolve to you all!
thank you for the heads-up about medicare.....you have written this so well, I think it would be a powerful read for folks in the papers.....
xoxoxo

Reply

Sheila

3/14/2015 05:22:55

Oh my, you are awesome. Only your efforts and those of your family made the difference. You are persistence in the face of adversity. Unlike Sisyphus you prevailed. Congrats to your mom for making her way back to her beloved granite state. Love to all!